In response to strong demand for the first malaria vaccine, recommended by the World Health Organization, 12 African countries will be allocated a total of 18 million doses for the period 2023-2025. This deployment is a crucial step in the fight against one of the most deadly diseases in Africa, killing nearly half a million children under the age of 5 and accounting for around 95% of cases of this infectious disease worldwide.
Since the World Health Organization recommended the use of the first malaria vaccine, RTS,S/AS01, for the prevention of Plasmodium falciparum malaria in children living in areas of moderate to high transmission, there has been a huge demand for doses.
In July 2022, Gavi, the Vaccine Alliance, offered funding to help eligible countries deploy this vaccine (and other malaria vaccines as they become available). Since then, more than 28 countries have expressed interest in obtaining the vaccine. Fourteen applications, submitted during the first two application opportunities (September 2022 and January 2023), have been recommended for approval by Gavi's Independent Review Committee (IRC). Currently, 18 million vaccines are available for the period 2023-2025. This number is insufficient to allow distribution in all the countries recommended by the IRC.
Since 2019, Ghana, Kenya and Malawi have been administering the malaria vaccine as part of the Malaria Vaccine Implementation Program (MVIP), coordinated by WHO and funded by Gavi, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and Unitaid. The RTS,S/AS01 vaccine has been administered to over 1.7 million children in the three countries mentioned above. It has proved safe and effective, leading to both a substantial reduction in severe malaria and a drop in the number of child deaths.
Vaccine allocation framework
In anticipation of the gap between demand and supply, in early 2022 WHO coordinated the development of an allocation framework to transparently allocate a limited quantity of malaria vaccines. The Allocation Framework Implementation Group, made up of technical staff from WHO, UNICEF, the Gavi Secretariat and the African Centers for Disease Control and Prevention (Africa CDC), was tasked with recommending the quantities of malaria vaccines to be allocated to countries. The process followed the principles, considerations and indicators defined by the allocation framework, namely: urgent need, maximum health impact, equitable sharing of benefits and assurance of continuation of the immunization program.
In addition to Ghana, Kenya and Malawi, the initial allocation of 18 million doses will enable nine other countries (Benin, Burkina Faso, Burundi, Cameroon, Democratic Republic of Congo, Liberia, Niger, Sierra Leone, Uganda) to introduce the vaccine into their routine immunization programs for the first time. This allocation cycle uses vaccine doses available to Gavi through UNICEF. The first doses of vaccine are scheduled to arrive in countries in the last quarter of 2023, and countries are expected to begin administering them in early 2024.
Other vaccines under development
Annual global demand for malaria vaccines is estimated at 40-60 million doses in 2026 alone, rising to 80-100 million doses a year by 2030. In addition to the RTS,S/AS01 vaccine, developed and produced by GSK and supplied in the future by Bharat Biotech, a second vaccine, R21/Matrix-M, developed by Oxford University and manufactured by the Serum Institute of India (SII), is also expected to be prequalified by the WHO soon. Gavi recently presented its roadmap for increasing supply to meet demand.